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LICENSE ELECTRICAL LOG <br /> MARION COUNTY DEPARTMENT OF PUBLIC WORKS <br /> • BUILDING INSPECTION DIVISION <br /> 5155 SILVERTON RD NE <br /> SALEM,OREGON 97305 <br /> PHONE#(503)588-5147 <br /> FAX#(503)588-7948 <br /> MASTER ELECTRICAL PERMIT <br /> LICENSE LOG <br /> PLANT NAME Co Vc .a �,,�G� . PHONE#:cO\ 3 Oyu 1 <br /> PLANT LOCATION:_qs,co 51,6aLk1L /Qd ,() FAX#: 56 3 30t 3 / 1 y <br /> MAILING ADDRESS:ygcb &Sc &J4 Rai() IQrtx "2. <br /> CITY: l. b00 1[_s STATE d e ZIP / <br /> TYPE OF STRUCTURE: -.3" th <br /> TYPE OF BLDG USE: __Lttet,Vgle.;ee_ I <br /> SUPERVISING ELECTRICIAN: 447' t•1-- A t OV _ —TO 3 J d ? 7 3 6� <br /> �1( <br /> CONTACT PHONE#:.sb3 S'O _ 47 36,6 7$"03 G ._, 3 l o N �. <br /> DATE NAME LICENSE#/TYPE EXPIRATION DATE <br /> lb/ (ab 41140444, Aft Ic.welc ,c??7 L.44 b I ( �� <br /> /6 -/ /e a c5--6 g 1a /// 2.( <br /> I 023//K 10`11 f 2.6 <br /> SIGNATURE OWNER/SUPERVISOR: DATE: <br /> I UNDERSTAND THAT THE MASTER PERMIT INSPECTION FEE IS$67.25+12% STATE <br /> SURCHARGE/HOUR PORTAL-TO-PORTAL,(MINIMUM ONE HOUR FOR A TOTAL OF$75.32). <br /> • PAYABLE PRIOR TO THE RELEASE OF THE INSPECTION REPORT.(OAR 918-309-0100.) <br /> Complete this form and return it to Building Inspection Division. The Electrical Inspector will contact you to schedule a <br /> date and time for your inspection. <br /> G:\Master Perrnits\License Electrical Log.doc 4/18 <br />